Provider Demographics
NPI:1619349727
Name:FERNANDES, LIGIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:LIGIA
Middle Name:
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 FAIRMONT LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3582
Mailing Address - Country:US
Mailing Address - Phone:305-582-4149
Mailing Address - Fax:
Practice Address - Street 1:473 FAIRMONT LN
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3582
Practice Address - Country:US
Practice Address - Phone:305-582-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12110224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant